Provider Demographics
NPI:1730419821
Name:PATEL, PRITIBALA S (RPH)
Entity type:Individual
Prefix:MISS
First Name:PRITIBALA
Middle Name:S
Last Name:PATEL
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1114 BRAWLEY SCHOOL RD
Mailing Address - Street 2:
Mailing Address - City:MOORESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28117-5937
Mailing Address - Country:US
Mailing Address - Phone:704-696-2583
Mailing Address - Fax:
Practice Address - Street 1:1114 BRAWLEY SCHOOL RD
Practice Address - Street 2:
Practice Address - City:MOORESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28117-5937
Practice Address - Country:US
Practice Address - Phone:704-696-2583
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-01-12
Last Update Date:2010-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCRPH17616183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist